Debate - from SYNTAX to FREEDOM and STICH: PCI is moving to centre stage

Introduced 40 years ago, percutaneous coronary intervention (PCI) has become the most frequently performed procedure for myocardial revascularisation, being preferred for more than three-quarters of patients [1]. Although the preferential use of PCI in lieu of conservative medical therapy in the setting of acute coronary syndromes is supported by several randomised trials and meta-analyses, the role of PCI for revascularisation in patients with stable coronary artery disease (CAD) still remains a matter of debate. Direct evidence from randomised trials failed to show a clear survival benefit over medical therapy for PCI in stable CAD [2], whereas a network meta-analysis of 100 randomised trials suggested that PCI with new-generation drug-eluting stents (DESs) reduces the risk of all-cause mortality compared with medical therapy, rivalling outcomes of coronary artery bypass grafting (CABG) [3]. In this article, we review the role of PCI and CABG as revascularisation modalities for patients with multivessel or left main CAD, and those with more challenging conditions such as ischaemic cardiomyopathy and diabetes.